For state, kidneys ini­tia­tive in­trigues

Arkansas third in re­nal deaths

Arkansas Democrat-Gazette - - Front Page - KAT STROMQUIST

Doc­tors and oth­ers in­volved in the care of Arkansans with kid­ney dis­ease are ea­ger to learn how a fed­eral ini­tia­tive an­nounced this week will ad­dress re­nal dis­ease in the state, which has one of the nation’s high­est rates of re­lated deaths.

Pres­i­dent Don­ald Trump signed an ex­ec­u­tive or­der Wed­nes­day di­rect­ing gov­ern­ment agen­cies to take ac­tion on chronic kid­ney dis­ease, in­clud­ing changes in pre­ven­tive care and pay­ment mod­els through the Cen­ters for Medi­care and Med­i­caid Ser­vices.

An over­all goal of the direc­tive is to dou­ble the num­ber of kidneys avail­able for trans­plant by 2030.

In a phone interview Thurs­day, Dr. Lyle Bur­dine, di­rec­tor for solid-or­gan trans­plants at the Univer­sity of Arkansas for Med­i­cal Sciences, was op­ti­mistic about the plan’s prospects but said he wanted to see more specifics.

“It’s a pretty vague state­ment, so it’s a lit­tle bit hard to know ex­actly how that’s going to affect us on a dayto-day ba­sis. But the over­all im­pres­sion I get is that it’s going to be help­ful,” he said.

“Any­time they bring aware­ness to end-stage or­gan dis­ease, I think it’s great. It only ben­e­fits … the pa­tients that are in our state with that prob­lem.”

Ac­cord­ing to the fed­eral Cen­ters for Dis­ease Con­trol and Pre­ven­tion, Arkansas has more kid­ney dis­ease deaths per 100,000 peo­ple — about 20 — than any states ex­cept Louisiana and Alabama. The rate of end-stage re­nal dis­ease in south­ern Arkansas also is among the coun­try’s high­est, Bur­dine said.

The prob­lem af­fects so many that a state en­tity, the Arkansas Kid­ney Dis­ease Com­mis­sion, of­fers pay­ment as­sis­tance for some med­i­ca­tions and ther­a­pies for peo­ple af­fected by the ill­ness, which is es­ti­mated to affect 37 mil­lion peo­ple in the United States.

U.S. Depart­ment of Health and Hu­man Ser­vices Sec­re­tary Alex Azar called the “Ad­vanc­ing Amer­i­can Kid­ney Health” plan the big­gest change to kid­ney dis­ease treat­ment — which ac­counts for about 20% of Medi­care ex­pen­di­tures —

in decades.

“Too many Amer­i­cans don’t know about or aren’t sup­ported in shift­ing to more con­ve­nient dial­y­sis op­tions, and too many Amer­i­cans never get a chance at a kid­ney trans­plant,” he said in a state­ment. “That has to change.”

Ma­te­ri­als re­leased by gov­ern­ment agen­cies Wed­nes­day say the fed­eral ini­tia­tive aims to im­prove out­comes by in­cen­tiviz­ing doc­tors who slow dis­ease pro­gres­sion, re­vamp­ing re­im­burse­ment rates, cre­at­ing fi­nan­cial sup­ports for liv­ing donors and im­prov­ing or­gan recovery.

At the Arkansas Re­gional Or­gan Recovery Agency, com­mu­ni­ca­tions di­rec­tor Au­drey Coleman said the staff watched a live-stream of the cer­e­mony announcing the plan, but em­ploy­ees were still di­gest­ing what it meant Thurs­day.

“We’re try­ing to fig­ure out what’s going with it, as well,” she said. “How it’s going to affect us lo­cally, it’s al­most im­pos­si­ble to say right now. … I think it’s going to affect the trans­plant cen­ters more than us.”

Trans­plants are the best and most eco­nom­i­cal treat­ment for peo­ple with kid­ney dis­ease. Com­pared with dial­y­sis, a kid­ney trans­plant pays for it­self in 14-15 months and can help a patient sur­vive 20 or 30 years, Bur­dine said.

While or­gan do­na­tion and trans­plant rates have been pretty good in Arkansas in the past few years, U.S. re­gional short­ages have be­come a prob­lem, Bur­dine said. Some more pop­u­lous states’ do­na­tion rates aren’t keep­ing up with their kid­ney dis­ease rates, and a solution that’s re­cently been floated might have draw­backs for Arkansas.

“One thing that’s be­ing bat­ted around is sort of ex­pand­ing, putting every­body in the same or­gan pool,” he said. “Sta­tis­ti­cally [that] sort of makes it dif­fi­cult for our pa­tients to get the care and or­gans they need when they get lumped in with larger states.”

To ad­dress short­ages, the fed­eral plan calls for pol­icy changes to re­duce the or­gan dis­card rate, such as a re­view of rules around donors who have hep­ati­tis C and the devel­op­ment of bet­ter match­ing tools. Right now, 18%-20% of kidneys that are pro­cured are dis­carded.

Another key com­po­nent of the fed­eral ini­tia­tive in­volves a shift away from dial­y­sis cen­ters, us­ing pay­ment in­cen­tives to al­low more peo­ple to get dial­y­sis at home.

Travel three times a week to and from cen­ters can be a fi­nan­cial and emo­tional bur­den on pa­tients, and home dial­y­sis can re­duce the risk of in­fec­tion, said Steve Fick­lan, re­gional op­er­a­tions di­rec­tor for Fidelity Home Dial­y­sis.

“[The fed­eral plan] is a push to­ward that, and we think it would be a good thing,” he said. “In­di­vid­u­als do bet­ter in their own environmen­t and set­tings, so cer­tainly there is a win-win and a plus there.”

Medi­care and Med­i­caid don’t cur­rently cover hemodial­y­sis — one of two types of home dial­y­sis — so for some pa­tients that treat­ment can be cost-prohibitiv­e, he said. At this time, his com­pany has just one cus­tomer re­ceiv­ing dial­y­sis at home. The rest go to cen­ters.

This is at least the third re­cent Trump ad­min­is­tra­tion pro­gram tar­get­ing a spe­cific

At the Arkansas Re­gional Or­gan Recovery Agency, com­mu­ni­ca­tions di­rec­tor Au­drey Coleman said the staff watched a live-stream of the cer­e­mony announcing the plan, but em­ploy­ees were still di­gest­ing what it meant Thurs­day.

pub­lic-health is­sue. Ear­lier ini­tia­tives have com­mit­ted re­sources to fight­ing use of opi­oids and end­ing the HIV epi­demic.

The kid­ney dis­ease plan also in­cludes a call for the Health and Hu­man Ser­vices Depart­ment to en­cour­age pub­lic-pri­vate part­ner­ships for kid­ney dis­ease re­search, in­clud­ing the devel­op­ment of im­plantable or wearable kidneys.

Bur­dine, who once trained at a Univer­sity of Cal­i­for­nia at San Fran­cisco cen­ter that has worked on an ar­ti­fi­cial kid­ney, said he doesn’t ex­pect that tech­nol­ogy to be im­me­di­ately on deck.

“I don’t see it hap­pen­ing in the next five to 10 years,” he says. “We need another or­gan source. I don’t think it’s un­rea­son­able to go after it, but it’s def­i­nitely not ready for prime time yet.”

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